MENA refugees face acute health crisis

A child receives polio vaccination at a Syrian refugee settlement in the Bekaa valley.

Washington - Violent conflicts in Arab countries are creat­ing a humanitarian and health crisis of unprece­dented magnitude. With millions of refugees and displaced people in need of the most basic services, the international support system is showing signs of fatigue. Many in besieged communities and refugee camps face a “slow death” from disease, which is becoming the number one killer. The most important, if depress­ing, message that emerged from a recent conference in Washington was that the health crisis will not end soon. Anne Patterson, US assis­tant secretary of state for the Mid­dle East, said that “the profound instability and violence gripping countries in the region over the past several years has done enormous damage to [health care] infrastruc­ture and basic services that will take years to repair”. Patterson said it was “dispiriting” and that “not too long ago, health care was something of a regional success story”. She noted that from 1970-2010, the Middle East/North Africa region registered the fast­est decline in infant mortality rates in the world and communicable diseases were no longer the high­est causes of death. But now, “we are seeing serious structural defi­ciencies across the board and this speaks to a larger breakdown in the Arab world”, Patterson said. Former US ambassador to Syria Robert Ford said he was not hope­ful that the humanitarian crisis would abate. Indeed, according to statistics from the UN High Com­missioner for Refugees (UNHCR), on average 17 years go by before refugees make it home after fleeing their countries. The refugee problem is com­pounded by deteriorating economic conditions, lack of basic health services to begin with and poor in­stitutions. The Washington confer­ence, which was sponsored by the Middle East Institute, highlighted a number of challenges to health care services. First and foremost are violence and war, which are directed at the population at large and at health care workers in particular. In Syria, for example, barrel bombs and dis­eases are the main causes of death. Dr Zaher Sahloul, president of the Syrian American Medical Society (SAMS), said the most important necessity is to stop bombing civil­ians and hospitals. “We have flight of doctors and nurses because they are targeted and cannot sustain their families,” he said. Dr Ala Alwan, executive direc­tor for the Eastern Mediterranean for the World Health Organisation (WHO), said 75% of global attacks on health workers occur in Syria. According to WHO, in Libya 2 mil­lion people are in need of humani­tarian assistance. And yet, Laila Bu­gaighis, deputy director general of the Benghazi Medical Centre, said most residents of Benghazi are cut off from care because 60% of health care facilities have shut down. Patterson pointed out that the United States is providing more than $1.6 billion to Jordan, Leba­non and Turkey “to mitigate the multiple stresses — including health care”. And in Iraq, “the US will spend $17 million on health care programmes for people who have fled [the Islamic State] and other violence”, she added. The United States also provided Iraq with $205 million in general humanitarian assistance. Ford said the United States spent $4 billion on humanitarian aid in Syria but when UNHCR launched an appeal for $4.5 billion it raised only $1 billion. But far more is needed. Alwan spoke of the effects the funding shortfall has on the work of interna­tional organisations. Among other things, it has led to postponement of immunisations. Syria, for exam­ple, had been free of polio for 50 years but new cases are now being seen. The donor money is not sufficient to handle the need. According to Thomas Staal of the US Agency for International Development, “We spend more money in the US buy­ing Coca-Cola than the money that goes to Syria.” Yet another problem impeding the work of health care organisa­tions is access. In Syria, the UN Security Council had to pass a reso­lution forcing the government to allow access for humanitarian aid and health care to besieged areas. That desperate state led the Syr­ian American Medical Society to issue a report titled Slow Death, documenting the plight of the more 640,000 Syrians living under long-term siege. The report says the sieg­es have “caused the complete col­lapse of local health care systems and forced the remaining doctors to practice in primitive conditions”. Andrew Harper, the UNHCR rep­resentative in Jordan, said there was not enough money to deal with the problem of Syrian refugees there and that Jordan was over­whelmed by the needs of its own population. One heartening fact is that regional countries are be­ing generous. Two years ago, said Alwan, 8% of WHO’s local funding came from the region. Now, most of it comes from the region. WHO also changed its way of working. Before, it was dealing with governments; now, it is dealing with non-gov­ernmental organisations (NGOs). In Yemen, Alwan said, WHO relies completely on NGOs. The speakers agreed that Russia, China and Iran have not been forth­coming in providing aid to Syria, which is ironic, given that two of them are the main supporters of the Assad regime and the main supplier of its weapons.